A 2-day-old infant with hydrocephalus returns from surgery following placement of a ventriculoperitoneal shunt. Which nursing intervention practical nurse (PN) implement during postoperative care? (Select all that apply.)

A. Document strict intake and output: Monitoring fluid balance is essential after ventriculoperitoneal shunt surgery, as changes in intracranial pressure and fluid status can impact recovery. Accurate recording helps detect complications such as over- or under-drainage. B. Place in Trendelenburg position: The Trendelenburg position is not recommended post-shunt surgery because it can increase intracranial pressure. Infants are generally positioned flat or with the head slightly elevated to promote optimal CSF drainage and reduce pressure on the surgical site. C. Monitor body temperature every 4-hours: Regular temperature checks are important for early detection of infection, a common complication after shunt placement. Prompt identification allows timely intervention and prevents sepsis or shunt malfunction. D. Measure head circumference daily: Daily head measurements help assess for increases in intracranial pressure or shunt malfunction. Tracking changes in head circumference is a critical component of postoperative neurological monitoring in infants. E. Irrigate shunt and pump valve every 12-hours: Shunt irrigation is not performed by nursing staff; it is a sterile procedure performed only by specialized providers if indicated. Routine pumping or irrigation by the PN is not appropriate and can cause harm.